Early investigational TNF receptor antagonists for the treatment of ulcerative colitis

Introduction: Ulcerative colitis (UC) is a life-long, immunologically mediated condition that results from an inappropriate activation of the mucosal immune system by intestinal luminal antigens in genetically susceptible individuals. TNF-alpha is a pro-inflammatory cytokine central to UC pathogenesis. Areas covered: This review examines the evidence for the use of the anti-TNF (alpha TNF) medications infliximab, adalimumab, certolizumab and golimumab in the management of UC. It highlights the newer biosimilar agents that are becoming available and the early stage investigation of an orally administered alpha TNF agent. Expert opinion: alpha TNF therapy is effective but only in a proportion of UC patients. As there is now strong evidence that UC is not just a single disease but a series of phenotypes with distinct genetic, serological and environmental aspects, understanding the heterogeneity of the innate immunological response in UC could allow for better targeted patient management. Identifying differences in the efficacy of the various alpha TNF agents is difficult as there are no head-to-head studies, but only infliximab has proven clinical efficacy in the management of acute severe colitis. Biosimilars to the alpha TNF agents are now available and with the added competition, medications costs should fall allowing for greater patient access.